Porcine heparin increases postoperative bleeding in cardiopulmonary bypass patients.
One hundred thirteen patients undergoing cardiopulmonary bypass were randomly assigned to receive either bovine or porcine heparin. Heparin was infused at 4.5 mg/kg during bypass and administered at the lesser of 70 units/kg or 5000 units/dose at 12-hour intervals postoperatively. Platelet counts decreased to 45% of preoperative levels during the first 3 days postoperatively (porcine, 44 +/- 13%, n = 50; bovine, 46 +/- 15%), but returned to preoperative levels by the seventh postoperative day. The average blood loss in the porcine heparin group significantly exceeded that of the bovine heparin group (porcine, 1350.7 +/- 727.8 ml; bovine, 1059.6 +/- 381.0 ml; p less than .01). Consequently, the platelet transfusion requirement was greater in the porcine heparin group (porcine, 1.7 +/- 3.9 units; bovine, 0.5 +/- 1.7 units; p less than .05); however, blood and blood component (with the exception of platelets) administration was not significantly different between the two groups. The four patients taking anticoagulants or antiinflammatory agents in the porcine group required a mean of 8.5 units of red blood cells (RBC) plus supplemental platelets. The seven such patients in the bovine group received a mean of 3.0 units of RBC and no platelets. Thus, the use of porcine heparin resulted in a generalized increase in postoperative bleeding with increased management problems in patients undergoing cardiopulmonary bypass.
Iverson
L I
LI
Cardiothoracic Surgery Department, Samuel Merritt Hospital, Oakland, CA.
Duhaylongsod
F G
FG
Young
J N
JN
Ecker
R R
RR
Ennix
C L
CL
Moretti
R L
RL
Farrar
M
M
Hayes
R
R
Lee
J
J
May
I A
IA
D000818:Animals; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D002417:Cattle; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010976:Platelet Count / Q000187:drug effects; D017713:Platelet Transfusion; D011183:Postoperative Complications / Q000139:chemically induced*; D011446:Prospective Studies; D013045:Species Specificity; D013552:Swine; D013921:Thrombocytopenia / Q000139:chemically induced*
D006493:Heparin